Washington — The health care overhaul package is the most far-reaching health legislation since the creation of the Medicare and Medicaid programs. While the underlying Senate bill is now law since President Barack Obama signed it Tuesday, additional changes will occur if the Senate passes the House of Representatives’ reconciliation-bill part of the package.
The following is a look at the impact of the entire package, which would extend insurance coverage to 32 million Americans but also would affect almost every citizen.
I don’t have health insurance. Would I have to get it, and what happens if I don’t?
Under the legislation, most Americans would have to have insurance by 2014 or pay a penalty. The penalty would start at $95, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016. This is an individual limit; families have a limit of $2,085. Some people would be exempted from the insurance requirement, called an individual mandate, because of financial hardship or religious beliefs or if they’re American Indians, for example.
Q: I want health insurance, but I can’t afford it.
A: Depending on your income, you might be eligible for Medicaid, the state-federal program for poor people and those with disabilities, which would be expanded sharply beginning in 2014. Low-income adults, including those without children, would be eligible as long as their incomes didn’t exceed 133 percent of the federal poverty level, or $14,404 annually for an individual and $29,326 for a family of four, according to current poverty guidelines.
Q: What if I make too much for Medicaid but still can’t afford coverage?
A: You might be eligible for government subsidies to help pay for private insurance that would be sold in the new state-based insurance marketplaces, called exchanges, slated to begin operating in 2014.
Premium subsidies would be available for individuals and families with incomes of 133 percent to 400 percent of the poverty level, or $14,404 to $43,320 for an individual and $29,326 to $88,200 for a family of four.
The subsidies would be on a sliding scale.
In addition, if your income were below 400 percent of the poverty level, your out-of-pocket health expenses would be limited.
Q: I own a small business. Would I have to buy insurance for my workers? What help could I get?
A: It depends on the size of your firm. Companies with fewer than 50 workers wouldn’t face any penalties if they didn’t offer insurance.
Companies could get tax credits to help buy insurance if they have 25 or fewer employees and a work force with an average wage of up to $50,000 a year.
Q: I’m over 65. How would the legislation affect seniors?
A: The Medicare prescription-drug benefit would be improved substantially. This year, seniors who enter the Part D coverage gap, known as the “doughnut hole,” each would get $250 to help pay for their medications.
Beyond that, drug-company discounts on brand-name drugs and federal subsidies and discounts for all drugs would reduce the gap gradually, eliminating it by 2020.
That means that seniors, who now pay 100 percent of their drug costs while they’re in the doughnut hole, would pay 25 percent.